Impact analysis of expanded access to ketamine for treatment-resistant depression

Abstract

Aim: This study aimed to estimate the economic impacts of expanded access to ketamine relative to electroconvulsive therapy (ECT) by offering intravenous ketamine to US patients with nonpsychotic treatment-resistant depression (TRD) and moderate-to-severe depression. Materials & methods: A population-level Markov simulation model with key parameters from a randomized trial was used to simulate the economic impacts of managing TRD with intravenous ketamine versus ECT over a 5-year horizon. Health states included response of depression in the acute treatment phase and continued treatment and relapse in the maintenance phase. The model estimated costs associated with healthcare utilization (direct costs) and time loss (indirect costs) from patient, caregiver, payer and societal perspectives. Model uncertainty was assessed with one-way sensitivity, probabilistic sensitivity and scenario analyses. Results: In year 1, our model included 350,000 eligible patients. In years 2 through 5, our model added 11,296 eligible patients annually. Expanded access to ketamine to manage TRD was projected to increase the number of patients receiving treatment by 75,000 patients in year 1 and 4292 patients annually in subsequent years. Over 5 years, expanded access to ketamine would result in a net positive societal savings of $828.2 million annually ($95.3 million to patients and $743.7 million to payers). However, expanded ketamine access would impose an additional $10.8 million burden on caregiver time annually. Conclusion: For US patients with TRD and moderate-to-severe depression, ketamine may be a noninferior treatment relative to ECT to improve depression symptoms. Expanded access to ketamine treatment would result in net savings to the patients, payers and society.<br /> <br /> <br /> <br /> What was the aim of this research? To estimate the economic impacts of expanded access to intravenous ketamine relative to electroconvulsive therapy by offering ketamine to US patients with treatment-resistant depression and moderate-to-severe depression without psychotic features from the patient, caregiver, payer and societal perspectives. How was the research carried out? A population level Markov simulation model and annual Markov was performed out to 5 years. Model parameters were identified from the literature, publicly available data sources and input from a clinical consultant. Sensitivity analyses were used to explore variations some inputs and assumptions. What were the results? Results suggest that expanded access to intravenous ketamine has the potential to increase the number of patients in treatment for treatment-resistant depression and lead to savings to society of US$828.2 million in total or US$19,940 per patient-in-treatment. Patients and incurred a total saving of $95.3 million and $743.7 million, respectively, annually. However, caregivers incurred an additional cost of $10.8 million annually. What do the results of the study mean? Expanded access to ketamine would result in net annual to society, patients and payers but would impose burdens on caregivers annually due to the additional time spent transporting patients to and from treatment.